Perspectives on 50 years of fetal monitoring from clinical leaders around the world

Prof. Dr. Diogo Ayres-de-CamposAssociate Professor, Medical School – University of Lisbon, and Secretary-General of the European Association of Perinatal Medicine (EAPM)

1. How have advances in technology changed the way you work? Technology has become a very important part of obstetrical care, particularly in fetal medicine and intrapartum care. There is far more technology in clinical care nowadays than when I first started practicing in the early 1990s, and huge progress has been achieved in pregnancy outcomes for both mother and child.

At the same time, healthcare professionals have had to adapt to the changing expectations of mothers-to-be for a more positive and relaxed experience during pregnancy and childbirth. In this sense, it’s not just about the technology – it’s about incorporating it wisely into clinical care, and focusing more on adequate communication with patients, as well as effective interactions with other healthcare professionals.

2. Which developments have surprised you the most during your time in the field of obstetrical care? Firstly, I witnessed enormous improvements in the diagnosis of fetal malformations, with the increasing quality of ultrasound machines, and then the incorporation of strategies for the screening of chromosomal abnormalities and other pregnancy complications.

Secondly, there have been significant advances in intrapartum fetal monitoring, with a far lower incidence of low fetal oxygenation being reported in several industrialized countries. This was partly because new methods of fetal monitoring were developed, but also because of the way information was made available to healthcare professionals. Remote and wireless monitoring enabled interactions that previously could only be accomplished by physically entering the labor ward. There has also been enormous progress in pain management during childbirth, allowing the labor ward to have a much more relaxed atmosphere.

3. How has the labor experience evolved from the mother’s perspective? In high-resource countries, expectations regarding childbirth have changed a great deal. Expectant mothers naturally continue to desire a safe childbirth, but many also want to remain fully mobile, to preserve all aspects of the emotional experience of childbirth, and do not want medical interventions without a clear explanation of why they are necessary.

We must remember that women should always remain at the center of attention during childbirth. Technology is there to help, but the focus needs to be on the mother and child.

4. How have public and clinical attitudes changed with respect to mobility in labor? In the 1990s, it was widely believed that expectant mothers could not remain fully mobile while being continuously monitored during labor. This led many women to decline continuous monitoring during childbirth, and for the technology to be seen as providing a negative experience. Advances in wireless transmission of signals now allow women to remain fully mobile during the whole process, while at the same time supporting continuous monitoring of the fetus.

5. What future advances would you like to see in the field of labor and delivery that would improve your job or the mother’s experience? Firstly, I would like to see evidence that the quality of fetal monitoring remains high at all times during mobility, without the need for invasive techniques such as fetal scalp electrodes. Secondly, I hope that innovations will allow a more objective and non-invasive monitoring of labor progress. Repeated vaginal examinations are uncomfortable and provide very subjective information.

Thirdly, computer analysis may be of help, allowing a more objective and discriminative method of assessing fetal oxygenation and labor progress. With all major aspects related to safety taken care of, healthcare professionals can focus more on the human side of labor, allowing women to fully enjoy the positive experiences of childbirth.

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